Te need to improve reporting of non-rouune events, errors, and preventable failures in the care of patients has emerged as one of the most important and challenging opportunities for the growing movement to advance patient safety. Reporting by itself, however, is only the first step in the critical process improvement sequence of detection, analysis, interpretation, solution implementation, and re- evaluation. Ideally, event reporting serves many functions in complex socio-technical systems, among them an indispensable contribution to organizational learning and continuous system improvement as well as being a mutually reinforcing component of safety culture. This demonstration project is a consortium effort of two large, geographically and ethnically diverse, integrated healthcare delivery systems: Columbia/Cornell/New York-Presbyterian Hospital and the University of Chicago Hospitals and Health system. The core of our project is a voluntary near miss Medical Event Reporting System (MERS) and a state-mandated incident reporting system, New York Patient Occurrence Reporting and Tracking System (NYPORTS). This integrated reporting system has been implemented in New York Presbyterian Hospital and is currently being rolled out to the constituent hospitals of the New York Presbyterian Network and the University of Chicago Network. The specific aims of this proposal are to: (1) Expand our integrated event reporting system, MERS, to facilitate reporting of errors by patients and test this novel approach encouraging safety reporting in a largely unexplored venue, the outpatient setting. (2) Test novel, generalizable, informatics methods that allow MERS to manage and support learning from large numbers of reports in an effective and efficient manner. (3) Demonstrate the value of reporting by showing its effects on patient safety, organizational culture, and economic outcomes. Moreover, we will demonstrate the added value of near miss reporting by showing how efforts to address the causes of near miss events prevent sentinel events. (4) Improve healthcare delivery processes and training using failure mode analysis, systems redesign, safety curricula, and simulation based team training linked to MERS outputs. (5) Discover what kinds of safety information models of dissemination are valued by consumers, purchasers, policy makers, providers and regulatory agencies, and explore the practical pros and cons of alternative policy strategies to develop and disseminate such information.